Resources

Slides by Alex Ryden, Brian Locke

Do you have what you need?

Learners will be able to:

  • Classify a situation as a rapid response or a code

  • Assess the need for escalation of care & resources

  • Organize responding personnel

First Scenario

Paged to bedside at U of U Hospital

  • Middle-aged man, new tachycardia & BP 65/42.

  • Oxygenating 90% on 2L by nasal cannula

  • Disoriented, somnolent, and diaphoretic

What do you do?

Analyze the Emergency

Stable or Unstable?

  • ABCs

  • What help do you have?

  • What help do you need?

Do you have what you need?

  • e.g. Charge RN to expedite transfer

  • e.g. Phlebotomy for labs

  • e.g. Respiratory Support

What do you need in this situation?

Resources vary across site

U of U IMED VA
RRT/MET House Sup, IM Res, SICU RN, Pharm IM, CICU RN, Nurse Sup, Pharm, RT, EKG, ABG, Lab IM, MICU, CNO, RNs, RT Pharmacy (7a-7p)
Code Blue add: Anesth, EMT, MICU res, Pharm add: ICU attgs add: ED
Numbers Shock Team, Cath, Brain Attack, VAD: 1-2222 Shock Team: Vocera TICU attg, Brain Attack: Operator/x33333 Brain attack: Page Neuro Senior, Cath: Page Cardiology, Code: x6666

Second Scenario

Paged to RRT at the VA

  • Elderly male who is hypoxemic immediately after a blood transfusion

  • RR 24, SpO2 82% on room air

Sick or not sick? Stable or Unstable? What else do you need?

Second Scenario, cont.

XR Chest Obtained During RRT

  • Begins to tripod with accessory muscle use.

  • Placed on 100% fio2 via face mask

  • O2 remains in the upper 80s

How has the situation changed?

Situations to Escalate

Rapid Response Code Blue
In 5 minutes, will this be a code? Brain Attack

•Airway

•In Extremis

 •Focal Deficit
•RRT → Code early

•Call brain attack

•Transfer after-hours at VA

Second Scenario, cont.

You call a code blue. Shortly, the patient loses their pulse.

  • Anesthesia at head of bed preparing to intubate

  • Single compressor starting to tire

  • Pharmacist trying to hand epi to RN on far end of the room

How can we improve things?

Room Management

  • Bed out from the wall (for airway)

  • Rotate bed (for compressor space)

  • Drop the bed for CPR

  • “Everyone clear out unless I’ve given you a role” Bed Management

Summary

  • Situations where you need other people? Airway, Cath/Shock Team, Neuro

  • Is this rapid really a code? Can’t breathe, extremis

  • Room control: move the bed out, lower the bed, send people away

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